Is Blockchain in Indian healthcare worth the challenges?

The underlying technology is to collect the data in real time, store it on multiple servers to make it hack resistant (nothing is hack proof), allow the access to authorised people only, and store a newer version every time the file is accessed.ETHealthWorld | Updated: May 09, 2018, 17:56 IST

Does a nation like India with 1.3+ billion population need a healthcare system where health data of each citizen can be safely stored and readily accessed? Undoubtedly yes. Does there exist technology to do such a humungous task? Let us assume it does. Has it been done at this scale? No, it has not been done at such a large scale. There are examples like Estonia and few more pilot projects where all the healthcare data services are transferred to a futuristic digital system called Blockchain which is secure, easily accessible, and introduces accountability to healthcare system. Imagine a patient file which is written with a permanent marker, is password protected, records the names of everyone who has opened or edited the file, and is available wherever whenever needed. Imagine a tablet of paracetamol that comes with the information about its manufacturing location, date and time stamp, the person handling the drug, the supply chain information, and all this information is legitimate. Imagine an insurance claim filed for a surgical procedure, the details are automatically pulled for the patient file written with the permanent marker, and there is negligible possibility of a fraudulent claim. These are all examples of benefits of Blockchain in Healthcare. The underlying technology is to collect the data in real time, store it on multiple servers to make it hack resistant (nothing is hack proof), allow the access to authorised people only, and store a newer version every time the file is accessed.

India is striving to achieve United Nations’ Sustainable Development Goal of providing Universal Healthcare (UHC) by 2030. For a sustainable UHC, India needs to implement a digital health solution which can make patient data accessible, reduce frauds in the insurance pay-outs, root out drug piracy, and introduce impeccable accountability in the system. India’s ambitious “Ayushman Bharat Yojana” offers National Health Protection Scheme (NHPS) to demonstrate its commitment to achieve UHC by 2030. NHPS implementation would be facing multiple challenges pertaining to funding allocation, service delivery, patient selection, and sustainability. Central to the success of this scheme would be the nation’s ability to leverage digital technology in simplifying tasks. Blockchain concept and technology offers multiple functionalities that would help in transforming public insurance space in India and NHPS sustainability.

The most popular application of Blockchain globally has been Bitcoin. People have shown confidence in the Blockchain technology underpinning Bitcoin exchange network. Various banks are trying to adopt this technology to reduce errors in their transactions. Insurance companies are experimenting with this tech to reduce claim processing time, costs, and frauds. Shipping industry is piloting projects where Blockchain powers real time tracking of goods. Healthcare usually is a late adopter of digital tech owing to highly regulated environment and negligible risk appetite. The benefit of such attitude is that we now know what challenges were faced by others, and how should we fix them if Blockchain were to be implemented in Indian scenario. Above all, the experience of other industries would enable us to answer the go or no-go question for implementing Blockchain in Indian healthcare. It should be noted that every solution comes with pros and cons. The Blockchain in healthcare comes with less understood challenges and doubtful benefits. For a prudent discussion, we must agree upon the fact that digital health solutions like electronic records have delivered less than expected. Thus, any digital solution in healthcare would undergo more scrutiny.

Blockchain needs high computing power to keep the transaction data encrypted. For this reason, multiple Bitcoin servers are used across the geographic locations. As a result, Blockchain solution consumes lot of electric energy and produce heat. India suffers a deficit of electric supply and the usual climate is hot in India. To save electricity India should consider reducing the number of servers or using a single server. Blockchain warehouses should be established in colder regions like hill tops with internet connectivity. The cost of running such a system needs to be evenly distributed across government, healthcare providers, pharmaceutical firms, insurance companies, and other beneficiaries.

The second challenge is that a uniform IT system for healthcare does not exist in India as of today. We have seen in past that a cocktail of multiple digital solutions create silos suffering from interoperability issues. Such a future state would defeat the purpose of simplifying user experience while reducing the cost to the overall system. But developing digital technology is a core strength for which Indian professionals are popular globally. May be, this is the opportunity for India to build something novel, fine tune it, and then sell it to the rest of the world. A collective and collaborative effort by government and Indian software giants is capable enough to materialize such a project. Initiatives like “Make in India” would be supportive of such programs. Given the success of Aadhaar, it is doable.

The third challenge is limited insight into the product lifecycle. Is a Blockchain solution valid for 5 years or 20 years? As the pace of innovation is increasing, does the future hold something more economical? For sure yes. Is there a business case to implement such a solution? Well, in late 1990s during the .com bubble, companies didn’t have a business case to build a website. Yet, every fortune 500 company spent millions to develop a web portal, hoping that this is the future. Blockchain has shown promise to make life better. Even without a business case, it would be astute to develop a ubiquitous digital system. Blockchain is not the final destination or panacea, but it would be an essential of many future technologies.

The fourth challenge specific to India is that we do not have prerequisite nuts and screws in place to launch a digital health system. Our clinics and hospitals are void of computers, patient files are hand written, and internet connectivity is porous. Initiatives like “Digital India” would support the provision of technology tools at root levels. There also exists an opportunity to leapfrog some of the classic platforms like desktops. A patient and doctor in rural India do not need a bulky computer to go digital. A smartphone and internet connectivity would suffice. The newer solutions are asset light and mobile friendly.

The list of challenges is not exhaustive as there are more challenges related to Blockchain implementation that are worthy of a discussion. Blockchain comes with some unique benefits of improving the quality of health data stored, reduction in the administrative efforts to handle patient data, and universal access to health data. The continuous surveillance and digital auditing though Blockchain would make private/public healthcare providers, drug manufacturers, and insurance companies impeccably accountable for their actions. Blockchain is going to be the driver of convergence between government, hospitals, pharmaceuticals, medical device manufacturers, and insurance providers. This means a better care to the patient and reduced costs for the system. A Blockchain network would boost the adoption of technologies like Artificial Intelligence (AI). AI in Indian healthcare prerequisites that nation is running on a data intensive secure system. AI holds a promise to increase the efficiency of medical staff, thus filling the gap of staff shortages in healthcare. Blockchain has the potential that deserves an effort to address the challenges and reap the benefits.

In conclusion, the objective to have a Blockchain powered unified digital health system in India is ambitious, challenging, and achievable. These are the best motivators in a job description. The healthcare in India is at a tipping point where people and medical staff have realised the need for a technology driven uniform system. National Health Policy (NHP) 2017 has endorsed the role of digital technology in future healthcare initiatives. The benefits of Blockchain technology are aligned with the objectives stated in NHP 2017. A successful NHPS would mark a milestone for Indian healthcare. The use to technologies like Blockchain would support the NHPS success story in writing. The time is right to display the capability India holds in implementing the world’s largest Blockchain health network to materialize the world’s largest national health insurance plan.

The author is a medical doctor and holds an MBA from IIM-A. He works for a global management consulting firm.

With immense pride “India Live” celebrated its 10th national conference in Mumbai from 28th February to 3rd March 2019. The conference turned out to be a gold mine of information, with emphasis on academics, education and exchange of knowledge with leaders in interventional cardiology from both India and abroad.